Shin Beomsu, Koh Won-Jung, Shin Sung Wook, Jeong Byeong-Ho, Park Hye Yun, Suh Gee Young, Jeon Kyeongman
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2016 Dec 22;11(12):e0168373. doi: 10.1371/journal.pone.0168373. eCollection 2016.
Bronchial artery embolization (BAE) is an important treatment option for short-term control of hemoptysis in patients with simple aspergilloma (SA). However, there are no data on the outcomes of BAE in patients with chronic pulmonary aspergillosis (CPA). In this study, the clinical characteristics and outcomes of BAE were investigated and compared in patients with CPA and SA.
We retrospectively analyzed the clinical data of 64 patients (55 [86%] with CPA and 9 [14%] with SA) who underwent BAE for life-threatening hemoptysis. The clinical characteristics and outcomes of BAE in CPA patients were compared to those of patients with SA.
The most common angiographic abnormality was hypervascularity (n = 60, 94%), followed by contrast extravasation (n = 50, 78%) and systemic-pulmonary shunt (n = 48, 75%), with similar incidence rates in both groups. Immediate success was achieved in 41 (64%) BAE procedures, but it was incomplete in 23 (36%) cases due to difficulty with the approach and/or overuse of contrast medium. Clinical failure of BAE was observed in only one (2%) patient. Complications following BAE were observed in four (6%) patients. Recurrence of hemoptysis was seen in a total of 33 patients (52%) within a median of 2.0 (0.3-10.0) months, and repeat BAE was performed in 25 (76%) of these cases. In comparing the outcomes of patients with CPA and SA, there were no differences in the rates of success of initial BAE, incomplete embolization, or clinical failure in the two groups. However, recurrence of hemoptysis tended to be higher in patients with CPA (55%) than in those with SA (33%). In addition, antifungal medications following BAE were more commonly prescribed in the CPA group (56%) compared to the SA group (0%).
BAE was a safe and effective procedure for the management of life-threatening hemoptysis in patients with CPA. However, recurrence of hemoptysis was common, especially in patients with CPA. Therefore, definitive treatment for CPA following successful BAE should be considered to ensure the long-term success of the embolization in these patients.
支气管动脉栓塞术（BAE）是单纯曲菌球（SA）患者咯血短期控制的重要治疗选择。然而，尚无关于慢性肺曲霉病（CPA）患者BAE治疗结果的数据。在本研究中，对CPA和SA患者BAE的临床特征和结果进行了调查和比较。
我们回顾性分析了64例因危及生命的咯血而接受BAE治疗的患者的临床资料（55例[86%]为CPA患者，9例[14%]为SA患者）。比较了CPA患者和SA患者BAE的临床特征和结果。
最常见的血管造影异常是血管增多（n = 60，94%），其次是造影剂外渗（n = 50，78%）和体肺分流（n = 48，75%），两组发生率相似。41例（64%）BAE手术取得了即刻成功，但23例（36%）因进路困难和/或造影剂过度使用而不完全成功。仅1例（2%）患者出现BAE临床失败。4例（6%）患者出现BAE术后并发症。共有33例患者（52%）在中位时间2.0（0.3 - 10.0）个月内出现咯血复发，其中25例（76%）进行了重复BAE。比较CPA和SA患者的结果，两组初始BAE成功率、不完全栓塞率或临床失败率无差异。然而，CPA患者咯血复发率（55%）往往高于SA患者（33%）。此外与SA组（0%）相比，CPA组（56%）BAE术后更常使用抗真菌药物。
BAE是治疗CPA患者危及生命咯血的安全有效方法。然而，咯血复发很常见，尤其是CPA患者。因此，应考虑在成功的BAE后对CPA进行确定性治疗，以确保这些患者栓塞治疗的长期成功。
